When I mentioned to a friend that this week’s Fat Girl’s Guide would be on dental hygiene, her initial reaction was skepticism -- and a little bit of a bristle. “Why is that a topic?" she asked, "I don’t need to brush my teeth differently because I’m fat."
She’s right, of course. The basics on brushing (twice daily, and after consuming sugary foods) don’t change based on a person’s weight. But many of us (including me!) might be surprised to learn that ongoing studies over the past five years have focused on the relationship between obesity and periodontal disease. Amazingly, something as deceptively simple as healthy gums can influence a woman's risk for serious conditions such as diabetes and heart disease.
Despite this riveting explanation, my friend's eyes glazed over as I spoke, until she finally proclaimed that a whole post on dental health would be “boring.” Readers, I’ll grant you that healthy gums may not seem as exiting as finding comfy undies or learning how to flirt, but we keep it real here at FGG, and that means balancing the sexy with the sensible. Right now there are just a few short paragraphs standing between you and a healthier, happier mouth. I think we’re both up for that challenge, don’t you?
Why your dental habits matter
Let’s start with a few basics. Why is the importance of brushing, flossing and visits to the dentist something that's drilled into our heads from the time we can hold a toothbrush? (Hint: It’s not just about making sure your dragon breath doesn’t kill living creatures.)
We all know how a “morning mouth” feels – the unclean, almost furry feeling on our teeth and gums. My best friend describes this sensation by saying, “My teeth are wearing sweaters.” In language that’s a bit more technical, the “sweatery” feeling is the sticky film of plaque that has accumulated on the teeth. Caused by bacteria present in the mouth, plaque happens to everyone -- young or old, fat or thin. If plaque isn’t removed daily, it hardens into yellow- or brown-colored tartar, which is more difficult to remove.
I’m admittedly not a medical expert in the field of – well, anything, really. So in writing this week's Guide, I enlisted the professional opinion of Dr. Phyllis Cook, DDS, MPH, PA. Dr. Cook owns her own periodontal practice in North Carolina, and her first order of business was defining for me the difference between a dentist and a periodontist: Periodontists complete three years of advanced training beyond dental school, and their focus is primarily in the supporting structures of the teeth, gums and bone. A high number of the procedures she completes are restorative or reconstructive in nature, as she works on a variety of patients with periodontal disease.
What is periodontal disease?
While it may sound complicated, periodontal disease is just the technical term for gum disease ("periodontal" means "around the tooth"). Most people have heard of the mildest form of periodontal disease, gingivitis, which causes red, swollen gums that bleed easily. If gingivitis remains untreated, it can progress into periodontitis -- characterized by plaque growing below the gum line, generating toxins that result in a breakdown of the surrounding gum tissue and bone.
Dr. Cook explains how gingivitis can progress to periodontitis: "When bacteria is present in the patient's gums, the bone structure moves away from the tooth. This causes deeper pockets between the gum and bone, causing the teeth to loosen. The deeper pockets allow more bacteria to gather, escalating the disease even farther if nothing is done to manage it."
"Periodontal disease is never cured," she says. "It's only managed with proper dental hygiene and routine visits for cleanings." In short: Periodontal disease never fully goes away and can result in your teeth falling out. Two very good reasons to avoid at all costs.
Women face unique risks for periodontal disease
As women of any size, the hormonal fluctuations we experience during our lifetimes (during major life events such as puberty, pregnancy and menopause, or as a result of taking birth control) do more than affect our moods, appetites, complexions, etc. Those same hormones also cause changes in our gum tissue, which can leave us more susceptible to periodontal disease.
"When a patient is pregnant or on birth control , her gum tissues hyper-react to bacteria (plaque). The gums become swollen and bleed easily," Dr. Cook says. Conversely, "At the more mature phase of a woman’s life, the lack of hormones can also change gum tissue and bone density. " Since we've already learned how vital bone integrity is to healthy bones and teeth, it makes sense that women with lower bone density (because of osteoporosis, for example) might be at higher risk for gum disease.
How diabetes affects periodontal disease
"While being overweight does not cause diabetes, it is a leading contributor," Dr. Cook says. "If the diabetes or glycemic index is not controlled the body does not defend effectively against the bacterial challenge of periodontal disease. Maintaining your dental health makes managing your diabetes easier." Similarly, she says, studies have shown that if a person is managing her dental health, positive effects can be seen in the management of her diabetes."
For overweight women currently working to manage their diabetes, as well as for women with higher risk because of weight and family history, "Good oral hygiene is critical, along with food choices that will control blood sugar levels," according to Dr. Cook.
Gum disease increases your risk for heart disease
Are you ready for a sobering fact? Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those with a clean bill of dental health. Don't see the connection? Neither did I.
"The mouth is the gateway to the body," Dr. Cook says, "and bacteria is present in everyone's mouth." Those higher bacteria levels present in patients with periodontal disease mean there's more bacteria attaching to fatty plaques inside the arteries and contributing to the clogging and blockage of arteries.
While gum disease alone doesn't cause heart disease, Dr. Cook says, "Chronic inflammation in the body is one more contributor -- just like cholesterol." Knowing that heart disease is a leading cause of death for adult women -- and that obesity increases the risk of heart disease -- it makes good sense for overweight women not to compound this risk with poor dental hygiene.
Maintaining good dental health isn't complicated
The good news is that keeping your teeth and gums healthy is far easier than sweating in the gym for hours a day. In fact, like me, you likely already know all the right stuff you should be doing. . . but don't always accomplish.
There’s no great secret to maintaining good dental health, Dr. Cook says. The key is to create a daily routine that includes smart, healthy food choices and consistent dental hygiene. Brushing your teeth (and tongue) after every meal and flossing daily will help keep your mouth in good shape between professional cleanings. And if you're the type of person who spends 20 minutes in the toothpaste aisle agonizing over the endless choices and recommendations, you're stressing too much, Dr. Cook says.
"The type of toothpaste can help if it makes the patient use it more," she says, "but it is only of benefit while it's is being used." The real result doesn't come from this brand or that brand, but rather from the mechanical removal of the plaque/bacteria accomplished by brushing and flossing.
And if you slack occasionally on brushing after every single meal, be sure you don't slack on this: “The single most important thing is to have regular cleanings and dental and gum examinations by a dentist and/or periodontist,” Dr. Cook says. These exams serve to evaluate periodontal health, allow feedback on oral hygiene and provide instruction on ways to improve one’s dental hygiene.
"Regular examinations for patients without periodontal disease should happen every six to twelve months.” If periodontal disease has been identified and treated in a patient, the frequency of "recare" (repeat visits for cleanings and check-ups) is specific to the patient and can be as frequent as every two months.
Why diet is important to dental health
“Foods high in sugar both natural sugars and refined sugars should be avoided because they contribute to tooth decay and periodontal disease,” Dr. Cook says. “When we see patients getting cavities these days, it is mostly attributed to non-diet soda or sugary mints on a very frequent basis.”
In addition to sugary drinks and mints, Dr. Cook lists non-sugar-free gum and candy, grapes, raisins (remember: high natural sugar content), and foods with high refined sugar content (like many breads) as ones that should be avoided or enjoyed in moderation. Tooth-friendly foods she’d love to see her patients consume more frequently include vegetables, proteins, milk, unsweetened dairy products, and sugar-free candy and beverages.
With a little bit of planning and a lot of diligence, maintaining good dental health is an attainable goal for almost everyone. And as someone who occasionally plays fast and loose with the notion of brushing after every meal, I'm ready to invest the few minutes a day it will take to help safeguard my long-term health. What about you?
Information from Dr. Phyllis Cook's web site and The American Academy of Periodontology contributed to this article. For a quick and easy way to assess your own risk of periodontal disease, take the quiz found here.